Thoughts on chronic illness treatment goals and the Washington Post piece “A doctor discovers an important question patients should be asked”

“Then I remember a visiting palliative-care physician’s words about caring for the fragile elderly: “We forget to ask patients what they want from their care. What are their goals?”I pause, then look this frail, dignified man in the eye.“What are your goals for your care?” I ask. “How can I help you?””

I wish the concept of patient-directed treatment goals could be brought to all forms of care. A general willingness to listen to what issues are most salient in our day to day lives, what we need to address most, least, how to improve our quality of life while providing treatment for an incurable disease.

I find the language frustrating, fragile elderly… there’s a mindset in medicine that imposes assumptions even when attempting to be the most understanding. Why are the elderly fragile? Why are the young people ‘tough’ why isn’t making me comfortable just as important as making me functional? What my doctor considers functional may not be what I consider functional.

The needs of an individual’s daily life vary from person to person and that fact is no different for the young, the middle-aged, or the elderly. It’s nice to see the concept discussed. If only we could move beyond these assumptions about the goals of particular ages, genders, races, or any non-patient directed assumptions about what makes a ‘successful treatment’. We might begin to shift control back to the patient, restoring something stripped almost instantly with the diagnosis of a chronic illness.